Surgery

Senior Clinician

Place an order for the referral in Epic.Before clinic ends, communicate the necessity and urgency of the referral to the TS.Inform ACT about the referral and send the patient to ACT.

Prior to surgery, make sure that patient has received appropriate pre-surgery instructions. Pay particular attention to which medications to continue vs stop, which can be informed by this and this. Review recommendations with Dr. Meah.

Teaching Senior

Include the necessity and urgency of the referral in the weekly referrals@mssm.edu email.

The Chief TS will be in contact re: whether the surgery is emergent, urgent, or elective.

If the surgery is emergent (e.g. AAA, appendectomy), the Chief TS will send the patient to the ED (if not done already).

If the surgery is urgent (e.g. incarcerating hernias, cholecystectomies), the Chief TS will coordinate with Dr. Susan Lerner in the surgery department.

If the surgery is elective (e.g. non-urgent hernia repair, non-urgent malignancy), the Chief TS will reach out for appropriate curbsides or send instruction to ACT/Referrals to make surgical consult appt (see below).

Prior to surgery, make sure that patient has received appropriate pre-surgery instructions. Pay particular attention to which medications to continue vs stop, which can be informed by this and this. Review recommendations with Dr. Meah.

Access to Care Team

Make sure the patient has charity care & Emergency Medicaid. If not, follow the process to obtain charity care & Emergency Medicaid for the patient.Once the patient has charity care & Emergency Medicaid, contact the Ambulatory Referrals Manager Greeshma Rajeev-Kumar.Call the patient to see if he/she can attend the appointment.Ensure that senior clinician and/or teaching senior has reviewed pre-surgery information with patient.

For further support, contact the Ambulatory Referrals Manager.

Cost

The cost of surgery to the patient is variable and will depend on whether a curbsided surgeon will be able to offer surgery pro bono or if Emergency Medicaid will cover the cost of the surgery. Unexpected costs, including pathology and anesthesia, should be anticipated in advance.

The cost of an appointment for patients with charity care level 1 is $15. Appointments will be more expensive for patients with a higher charity care level. For these prices, contact the Ambulatory Referrals Manager.

Wait time

It takes about 2 weeks after a patient has received charity care for an outpatient surgery appointment to be scheduled. Urgent referrals can be expedited. Contact the Ambulatory Referrals Manager if the referral is urgent and needs to be expedited.